Does Medicare Provide Coverage for Orthotics?

Medicare offers coverage for orthotic devices when they are medically necessary and prescribed by a healthcare professional. These devices, such as braces and supports, play a vital role in managing conditions affecting the feet, ankles, and legs, especially in patients with diabetes-related complications.

Orthotics involves the use of specialized devices like braces and splints—known technically as orthoses—to assist in the treatment of limb and joint disorders. Medicare covers the provision, fitting, and treatment involving these orthotic devices when prescribed.

Continue reading to understand which Medicare parts cover orthotics, who can prescribe them, and the eligibility criteria for coverage.

Does Medicare Cover Custom Orthotic Devices?

Medicare provides coverage for custom orthotic devices primarily for individuals with diabetes and significant diabetes-related foot conditions. Coverage includes medically necessary ankle-foot orthoses and knee-ankle-foot orthoses.

These orthotic devices and their fittings are typically covered once per calendar year.

Orthotic devices covered by Medicare include:

• Custom-molded shoes and inserts (one pair annually)
• Extra-depth shoes (one pair annually)
• Inserts for custom-molded shoes (two pairs annually)
• Inserts for extra-depth shoes (three pairs annually)
• Shoe modifications as an alternative to inserts

Which Medicare Parts Cover Orthotics?

Coverage for orthotics may come from Original Medicare (Parts A and B), Medicare Advantage (Part C), or Medigap plans, depending on your specific situation.

Medicare Part A

When orthotic services are part of inpatient hospital care or Skilled Nursing Facility (SNF) stays, Medicare Part A may cover the associated costs if certain conditions apply:

• The orthotic device is provided before or during a Part A-covered hospital or SNF stay.
• The medical necessity arises during the inpatient stay, such as post-surgical needs.
• The orthosis is used for medically required treatment or rehabilitation during the inpatient period.

Medicare Part B

Part B covers outpatient orthotic care, including braces like ankle-foot orthoses and knee-ankle-foot orthoses, when prescribed by a Medicare-enrolled physician or healthcare provider.

Medicare Advantage (Part C)

Medicare Advantage plans must provide at least the same coverage as Original Medicare, including orthotic devices, and may offer additional benefits.

Medigap

Medigap plans can help cover out-of-pocket expenses such as deductibles, copayments, and coinsurance related to orthotic care.

What Are the Costs of Custom Orthotics with Medicare?

To maximize Medicare benefits, ensure that your physician and orthotic suppliers accept Medicare assignment. If providers do not accept assignment, you may be liable for higher charges.

Medicare Part A

If orthotics are covered under Part A during a hospital or SNF stay, you may be responsible for:

Part A Deductible

In 2024, the inpatient hospital deductible is $1,632 per benefit period.

Inpatient Stay Costs (Hospital)

Costs vary based on length of stay:

• Days 1-60: Deductible applies
• Days 61-90: $408 per day
• Days 91-150: $816 per day using lifetime reserve days
• After 150 days: Full cost responsibility

Inpatient Stay Costs (SNF)

• Days 1-20: Covered by Part A
• Days 21-100: $204 per day
• After 100 days: Full cost responsibility

Medicare Part B

Part B requires an annual deductible of $240 in 2024 and covers 80% of Medicare-approved orthotic costs. You are responsible for the remaining 20%.

Medicare Part C

Out-of-pocket costs vary by Medicare Advantage plan and may include copayments and deductibles.

Medigap

Medigap plans may cover deductibles, copayments, and coinsurance depending on your specific plan.

Who Is Authorized to Prescribe Orthotics?

For Medicare coverage, orthotics must be prescribed by a qualified physician who accepts Medicare assignment. Orthoses must be obtained from authorized healthcare professionals, including:

• Podiatrists
• Orthopedists
• Prosthetists
• Pedorthists
• Other certified orthotics specialists

Frequently Asked Questions

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Does Medicare Cover Arch Supports?

Medicare may cover arch supports if they are prescribed by a doctor and deemed medically necessary.

Is a Prescription Needed for Orthotics?

Some orthotic devices are available over the counter, but Medicare coverage requires a prescription from a qualified physician who accepts Medicare assignment.

Does Medicare Cover Shoes for Neuropathy?

Medicare Part B can cover certain orthotic shoes for individuals with diabetes-related neuropathy if prescribed by a qualified healthcare provider and meeting Medicare’s medical necessity requirements.

Summary

Medicare provides coverage for orthotic devices when prescribed by a qualified medical professional and deemed medically necessary. This includes treatment for diabetes-related foot conditions and necessary ankle-foot and knee-ankle-foot orthoses. Coverage options span Medicare Parts A, B, C, and Medigap plans, helping reduce the financial burden of orthotic care.

Ensure your healthcare providers and suppliers accept Medicare assignment to optimize your benefits and minimize out-of-pocket expenses.

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